Sabine Herget

Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review.

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Who Should We Target for Diabetes Prevention and Diabetes Risk Reduction

Screening for individual diabetes risk is crucial to identify adult and pediatric high-risk target populations for referral into successful diabetes prevention programs. Determination of impaired glucose tolerance or elevated fasting glucose levels has been the “gold standard” to classify subjects at increased risk for and/or to diagnose type 2 diabetes (T2DM). However, this led to ignoring many individuals prone to develop the disease. Therefore, using a stepped strategy consisting of a preliminary assessment of risk factors, by using risk scores such as the Finnish Diabetes Risk Score (FINDRISC) adapted to the respective population, followed by a single blood test determining blood glucose or hemoglobin A1c, respectively, or an oral glucose tolerance test is a feasible and pragmatic method to more accurately detect individuals at risk for T2DM. Inclusion of further risk factors into the assessment such as physical inactivity, waist circumference, and prenatal factors needs to be thoroughly discussed to establish a valid and reliable stepped approach applicable to real world health care. This article provides an overview of the current literature and is intentionally focused on the identification of high-risk populations (both adult and pediatric) that will help to address the key issues around the prevention of T2DM in health care settings.

Telephone-Based Adiposity Prevention for Families with Overweight Children (T.A.F.F.-Study): One Year Outcome of a Randomized, Controlled Trial

The one-year outcome of the randomized controlled T.A.F.F. (Telephone based Adiposity prevention For Families) study is presented. Screening of overweight (BMI-SDS > 90th centile) children 3.5–17.4 years was performed via the German CrescNet database, and candidates were randomized to an intervention group (IG) and control group (CG). The intervention consisted of computer-aided telephone counselling for one year, supported by mailed newsletters. The primary endpoint was change in BMI-SDS; secondary endpoints were eating behavior, physical activity, media consumption, quality of life. Data from 289 families (145 IG (51% females); 144 CG (50% females)) were analyzed (Full Analysis Set: FAS; Per Protocol Set: PPS). Successful intervention was defined as decrease in BMI-SDS ≥ 0.2. In the FAS, 21% of the IG was successful as compared to 16% from the CG (95% CI for this difference: (−4, 14), p = 0.3, mean change in BMI-SDS: −0.02 for IG vs. 0.02 for CG; p = 0.4). According to the PPS, however, the success rate was 35% in the IG compared to 19% in the CG (mean change in BMI-SDS: −0.09 for IG vs. 0.02 for CG; p = 0.03). Scores for eating patterns (p = 0.01), media consumption (p = 0.007), physical activity (p = 9 × 10−9), quality of life (p = 5 × 10−8) decreased with age, independent of group or change in BMI-SDS. We conclude that a telephone-based obesity prevention program suffers from well-known high attrition rates so that its effectiveness could only be shown in those who adhered to completion. The connection between lifestyle and weight status is not simple and requires further research to better understand.

Cardiometabolic risk markers, adipocyte fatty acid binding protein (aFABP) and the impact of high-intensity interval training (HIIT) in obese adolescents

OBJECTIVE The impact of high-intensity interval training (HIIT) as well as the association between the adipocyte fatty binding protein (aFABP) and cardiometabolic risk factors in overweight adolescents was investigated. METHODS Twenty-eight adolescents (13-18years; BMI≥90th percentile according to German reference values) were offered HIIT twice weekly for 6months. At baseline and after program completion, anthropometric, clinical and metabolic characteristics were assessed and a fasting blood sample was obtained. Leptin, adiponectin, visfatin and aFABP were measured using commercially available kits. DNA methylation at RALBP1 was assessed using pyrosequencing. Descriptive statistics, Pearsons correlation and linear models were calculated. RESULTS Mean age at start of the program was 15.5±1.4years (53.5% females) and 20/28 (71%) provided follow-up data. At baseline, aFABP was correlated with BMI-SDS (0.48 [0.13,0.72]; p=0.0095), waist-to-height-ratio (0.63 [0.33,0.81], p=0.00036) and body fat content (0.55 [0.21, 0.77]; p=0.0031). Certain markers of metabolic risk were significantly correlated with aFABP (HOMA-IR 0.52 [0.19, 0.75], p=0.0044; γGT 0.48 [0.13, 0.73], p=0.0091; uric acid 0.46 [0.11, 0.71] p=0.013; HDL-C -0.39 [-0.66, -0.01] p=0.043; triglycerides 0.38 [0.01, 0.66], p=0.047). With the exception of triglycerides, these associations vanished after adjusting for BMI-SDS. aFABP did not depend on sex, age or pubertal stage in obese adolescents. After the HIIT program, small but significant reductions were observed in waist-to-height-ratio, (0.013 [0.0025, 0.024]; p=0.023), skin-fold based body fat content (2.0% [0.6, 3.5]; p=0.011), and standard deviation score of systolic blood pressure (0.69 [0.26 to 1.1]; p=0.0036). No changes were observed in adipokines or epigenetic markers following the program. CONCLUSION HIIT may have beneficial effects on body composition and cardiometabolic health in overweight adolescents. Like in adults, aFABP seems to be associated with markers of metabolic risk in obese adolescents.

Psychosocial Well-Being of Adolescents Before and After a 1-Year Telephone-Based Adiposity Prevention Study for Families

PURPOSE Body image and psychosocial well-being play an important role in influencing health behavior of obese adolescents. Effects of family-based interventions on self-image and mental well-being are poorly understood. The effects of a parent-delivered intervention on psychosocial well-being in obese adolescents were investigated. METHODS A subset of secondary variables from the randomized-controlled Telephone-based Adiposity prevention study For Families (T.A.F.F. study) was analyzed. Multivariate analysis of variance and Pearson correlations were used to examine intervention effects on measures of body image, body dissatisfaction, self-efficacy, self-worth, and resilience and changes of standard deviation score of body mass index (BMI-SDS). RESULTS A total of 154 randomized adolescents participated in this study (10-17 years). Body dissatisfaction decreased between baseline and follow-up (p = .013, confidence interval [CI], .03-.29), whereas self-efficacy increased (p = .022; CI, -1.73 to -0.14). Both were independent of the randomization arm. Initial body image was a negative predictor of self-efficacy after the intervention. Changes in body dissatisfaction and self-efficacy were positively correlated with changes in self-worth and resilience but were not related to changes in weight status. CONCLUSIONS Overweight/obese adolescents have a high level of body dissatisfaction, more pronounced in girls than in boys. Interactions within families during overweight and obesity interventions need to be investigated in relation to adolescent body self-concept.

High-Intensity Interval Training for Overweight Adolescents: Program Acceptance of a Media Supported Intervention and Changes in Body Composition.

High-intensity interval training (HIIT) consists of short intervals of exercise at high intensity intermitted by intervals of lower intensity and is associated with improvement of body composition and metabolic health in adults. Studies in overweight adolescents are scarce. We conducted a randomized controlled trial in overweight adolescents to compare acceptance and attendance of HIIT with or without weekly motivational encouragement through text messages and access to a study website. HIIT was offered for six months (including summer vacation) twice a week (60 min/session). Participation rates were continuously assessed and acceptance was measured. Clinical parameters were assessed at baseline and after six months. Twenty-eight adolescents participated in this study (age 15.5 ± 1.4; 54% female). The standard deviation score for body mass index over all participants was 2.33 at baseline and decreased by 0.026 (95% CI −0.048 to 0.10) units, p = 0.49. Waist to height ratio was 0.596 at baseline and decreased by 0.013 (95% CI 0.0025 to 0.024), p = 0.023. Participation within the first two months ranged from 65% to 75%, but fell to 15% within the last three months. Attendance in the intervention group was 14% (95% CI −8 to 37), p = 0.18, higher than the control group. Overall program content was rated as “good” by participants, although high drop-out rates were observed. Summer months constitute a serious problem regarding attendance. The use of media support has to be assessed further in appropriately powered trials.

Case management via telephone counseling and SMS for weight maintenance in adolescent obesity: study concept of the TeAM program

BackgroundIn-patient obesity treatment programs for adolescents are associated with good success and substantial weight loss. However, maintaining weight loss remains a challenge. This article presents the concept of the TeAM (Te lephone counseling as A diposity M anagement) program. TeAM is an innovative, weight maintenance program for obese adolescents after in-patient therapy. It applies the case management approach in combination with new media (telephone counseling, web forum, and SMS messaging). Adolescents (14–18 years) were recruited via German rehabilitation hospitals. The intervention of the TeAM program consists of telephone counseling through trained case managers in order to maintain body weight reduction (expressed as BMI-SDS: body mass index standard deviation score) achieved during an in-patient obesity therapy. At baseline and after completion of the program, participants provide anthropometric measures (obtained by trained medical staff) as well as information on socio-demographics, usage of health services, psychosocial status, daily physical activity, media consumption, and eating behavior. The core of the intervention is regular telephone contact with the adolescent participants combined with tailored SMS messages. Telephone counseling is based on the systemic approach and addresses the topics of mental hygiene, physical activity, sedentary behavior, diet and eating behavior.ResultsBaseline data of the feasibility study: Thirty-eight adolescents were recruited for the feasibility study (14 male, 24 female; mean age 15.82 years); out of them, ten participants lived with a single parent; 68% planned to graduate from school without pre-requisites for university admission (O-level). The mean weight loss during in-patient treatment was 0.32 BMI-SDS units. Mean BMI at the start of intervention was 31.93 kg/m2, corresponding to a mean BMI-SDS of 2.48.ConclusionsWeight maintenance treatment programs for adolescent obesity utilizing new media are a promising approach as they reach adolescents directly within their everyday life.Trial registrationDRKS00004583.

Psychosocial status and mental health in adolescents before and after bariatric surgery. A systematic literature review.

Conservative treatment for juvenile obesity often shows limited efficacy. Therefore, bariatric surgery is increasingly considered a treatment option for extremely obese adolescents. For designing appropriate pre- and post-operative care, mental health status and psychological comorbidities of this target group need to be elucidated. A systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, Pubmed and Medline. Eleven studies met inclusion criteria. Results suggested that preoperatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while 50–70% showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Postoperative reports on anxiety and eating disorder symptoms among adolescents were not found. Further attention is needed in clinical assessment and treatment of mental health disturbances in adolescents presenting for bariatric surgery, while future research should focus on eating disorder and anxiety symptoms as well as psychological predictors of weight loss in adolescents after bariatric surgery.